CPR on a Loved One: Should/Would You Watch?
There has been much debate over the recent decades since cardio-pulmonary resusciation (CPR) has
become the established medical response to when a heart stops pumping about whether it
was appropriate for both a family member or the medical staff to have a family member present
and observe that procedure. The debate has mostly been amongst the medical professionals themselves
who are involved in the CPR procedure. However, whatever studies have been performed to try to clarify an
answer to the question overall tend to favor and not discourage family attendance. A current statistical study of the emotional outcomes of family members in France who either witnessed or did not witness CPR being performed on their loved one was published March 14 2013 (volume 368, number 11, page 1008) in the New England Journal of Medicine. The study was looking for the evidence of and magnitude of post traumatic stress disorder (PTSD) in those family who witnessed CPR and those who did not, along with medical staff issues was consistent with what has been considered previously that "family presence during CPR was associated with positive results on psychological variables and did not interfere with medical efforts, increase stress in the healthcare team, or result in medicolegal conflicts." In fact, those who watched CPR even in the resulting death of their loved one were psychologically better off than those who were in the vicinity but did not watch.
But, on developing this thread, my intention was not necessarily to have my visitors review the statistical evidence presented in this or previous studies but really to discuss the personal thoughts or feelings about participating as an observer when a family member is undergoing CPR. Perhaps, some visitors may have actually experienced such an activity.
CPR is, as a medical response to cardiac arrest, a rather hurried and intensely active process, with clinical confirmation f the arrest and maintaining monitoring for a heartbeat, attention to get the patient into the proper position for effective chest compression, beginning vigorous chest compression after establishing that an initial open airway is available until an endotracheal tube is inserted for mechanical ventilation. Then may come an electric shock applied to the chest to start a heart rhythm or improve a rhythm which causes the patient's body to violently jerk. Meanwhile, there must be the need for coordination of the activities by the staff involved and then final decision making of when to end an unsuccessful attempt at resuscitation. So where is the family visitor in all of this? Where should the family visitor stand and should there be a staff member dedicated to attend directly to the needs or questions of the visitor? Should the family visitor take any role at all in any decision making with regard to stopping or continuing the resuscitation attempt? Are these witnessed last moments of the loved one's life something to be thought of and sought as of value to the family? If so, of what value? Should you or would you watch? These are just some of the questions I would like to ask my blog visitors. Maybe you have some additional issues to discuss. If you have witnessed CPR at home by paramedics or in a hospital environment, can you tell us about your experience? ..Maurice.
Graphic: From Google Images
posted by Maurice Bernstein, M.D. @ 10:36:00 PM
5 comments
5 Comments:
I told the ICU nurse that no matter what I saw, I wanted to be there. She honored my request, and I was there watching CPR on a loved one. No one really told me where to stand, but in the great crowd of people watching (teaching hospital) I naturally was perhaps 8 feet away, out of the way. It doesn't look like it does on TV, it's a fairly violent looking procedure really.
But I was glad I was there. In fact, it was I who told them they could stop, that they weren't going to get her back. It was the last thing I could do for her.
I would have been terribly distressed to have been denied being at her side. I think it is the family's right, if it is what they want.
TAM
TAM, I am glad to read that you were satisfied regarding your CPR experience with a relative. What I am wondering is the part about your telling the staff that "they could stop" the attempt to resuscitate. The decision to terminate CPR is usually a medical technical decision based on the duration of the attempt, the complications to the treatment and the evidence of the heart's capacity and signs of attempts to respond. Also consideration of the patient's underlying disease might play a role in the decision. However, as with the implied permission to begin CPR by there being no "do not resuscitate" order" as established by the patient or legal surrogate, it certainly would be reasonable for the staff to stop CPR on the basis primarily on the request of an informed legal surrogate. I don't have any experience or knowledge about reactions to such requests. Was that your case? ..Maurice.
I was the legal surrogate. I would think (hope) that if they really thought I was making the wrong decision and that she had a good chance that they would have questioned me, but I believe in this case they probably thought she wasn't going to make it. They were asking each other for ideas or something and I said "You can stop, you aren't going to get her back". They didn't say a word in response, just stopped and pronounced her.
I do truly believe that it was hopeless, or I would not have made that decision. CPR had gone on a while, she had aspirated, and she was elderly.
Interesting, I think that most of the medical staff were more uncomfortable having me there than I was. Someone called out "family in the room" and people looked a bit worried. One young resident or student did say something inappropriate, and then got most glared at by physicians and apologized. She was just young, I wasn't offended, but they were horrified.
It makes me think that perhaps they were not used to having family there, I know some questioned it, but that ICU nurse insisted that I had said what I wanted. And it was the right decision for the patient and I. I had promised her that I wouldn't let her end up in some awful hopeless state, and I'm glad I was able to help make sure that didn't happen.
TAM
TAM, thanks for detailing your experience. I would think that it is improbable that most resuscitation teams have much or any experience with family members observing their work on the wards and therefore they might be poorly prepared to handle the family reactions or requests. I hope we get some hospitalists or ER docs to this thread to relate their experience or concerns on this topic. ..Maurice.
You're welcome. They did ok. They just seemed uncomfortable, and didn't seem to know what to say to me even after she died. There was a remarkable lack of emotion. Myself, I was basically shocked, as earlier that day they were planning to discharge her to rehab, and this was unexpected. But no one was unkind, and I am still glad that I was with her until the end. The ICU nurse was great, she was there in the initial team call and had spent a couple hours with me and the patient before we went up to the unit, so I guess she believed I meant what I said when I told her that I wanted to be there.
TAM
Post a Comment
<< Home